Boston Scientific (BSX) Bernstein 42nd Annual Strategic Decisions Conference summary

Business performance and outlook

• Organic growth guidance for 2026 was revised down to 6.5%-8% for the year, with Q2 expected at 5%-7% and confidence in meeting margin and EPS goals despite challenges.

• Key headwinds include slower growth in WATCHMAN standalone procedures, increased competition in EP, and softness in urology, prompting a prudent guidance reset.

• Growth drivers into 2027-2028 include new product launches in EP (FARAWAVE Ultra, FARAPOINT, FARAFLEX), next-gen WATCHMAN, and expansion in interventional cardiology and vascular segments.

• Penumbra acquisition and MiRus investment are expected to strengthen the portfolio, especially in neurovascular, peripheral vascular, and TAVR markets.

• Continued focus on double-digit EPS growth, margin improvement, and leveraging innovation pipeline for long-term differentiated growth.

WATCHMAN and EP segment trends

• WATCHMAN faces declining standalone procedure growth but increasing concomitant use; flat revenue expected Q1–Q3, with long-term optimism tied to CHAMPION-AF trial and label expansion.

• Operational and capacity challenges in hospitals are impacting WATCHMAN standalone growth, with ongoing efforts to improve workflow and education.

• EP business remains a global leader in PFA, with portfolio expansion (FARAPOINT, FARAPULSE Ultra, FLEX) and mapping (OPAL) as key strategies to regain share by 2027.

• Integrated imaging and mapping are critical, with ongoing investments in OPAL systems and software to support procedural expansion.

• ASC adoption for AF ablations is expected to reach 10%-15% of the market over the next two years, helping address workflow constraints.

Portfolio strategy and M&A

• The company operates eight business units, focusing on interventional medicine and leveraging internal R&D, venture investments, and M&A to fill product gaps and enter high-growth markets.

• Penumbra acquisition fills strategic gaps in neurovascular and peripheral vascular, with plans to retain commercial and R&D teams and run it as a standalone business.

• MiRus investment aims to disrupt the TAVR market with a novel rhenium alloy valve, offering advantages in durability, size, and procedural outcomes.

• Future M&A is expected to return to smaller, tuck-in deals, with a focus on cardiovascular and MedSurg areas through the venture portfolio.

• $2 billion share repurchase announced, with leverage expected to temporarily rise above 3x post-Penumbra, then return to 2.25x-2.5x.